1. WHAT CIALIS IS AND WHAT IT IS USED FOR
Cialis is a treatment for men with erectile dysfunction. This is when a man cannot get, or keep a hard, erect penis suitable for sexual activity.

Cialis belongs to a group of medicines called phosphodiesterase type 5 inhibitors. Following sexual stimulation cialis works by helping the blood vessels in your penis to relax, allowing the flow of blood into your penis. The result of this is improved erectile function. Cialis will not help you if you do not have erectile dysfunction.

It is important to note that cialis does not work if there is no sexual stimulation. You and your partner will need to engage in foreplay, just as you would if you were not taking a medicine for erectile dysfunction.

2. BEFORE YOU TAKE CIALIS
Do not take CIALIS:
If you are taking any form of organic nitrate or nitric oxide donors such as amyl nitrite. This is a group of medicines ("nitrates") used in the treatment of angina pectoris ("chest pain"). Cialis has been shown to increase the effects of these drugs. If you are taking any form of nitrate or are unsure tell your doctor.

- if you have serious heart disease or have had a recent heart attack.
- if you have had a recent stroke.
- if you have low blood pressure or uncontrolled high blood pressure.
- if you are allergic (hypersensitive) to tadalafil or any of the other ingredients of cialis

Take special care with CIALIS
Sexual activity carries a possible risk to patients with heart disease because it puts an extra strain on your heart.

The following are reasons why cialis may also not be suitable for you. If any of them apply to you, talk to your doctor before you take the medicine:
You have sickle cell anaemia (an abnormality of red blood cells), multiple myeloma (cancer of the bone marrow), leukaemia (cancer of the blood cells) or any deformation of your penis.
You have a serious liver or kidney problem.

Taking other medicines
As a general rule, always tell your doctor if you are taking or have recently taken any other medicine, even those not prescribed, because occasionally they might interact. This is particularly important if you are treated with nitrates as you should not take cialis if you are taking these medicines. A type of medicine called an alpha blocker is sometimes used to treat high blood pressure and enlarged prostate. Tell your doctor if you are being treated for either of these conditions. Do not take cialis with other medicines if your doctor tells you that you may not.You should not use cialis together with any other treatments for erectile dysfunction. Cialis is not intended for use by women or by children under the age of 18.

Driving and using machines
As dizziness has been reported in men taking cialis in clinical studies, you should be aware of how you react to cialis before you drive or use machinery.

Information for men intolerant of lactose, one of the ingredients of cialis:
Cialis contains lactose and should not be taken by patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

3. HOW TO TAKE CIALIS

Always take cialis exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

The recommended starting dose is one 10 mg tablet before sexual activity. If the effect of this dose is too weak your doctor may increase the dose to 20 mg. Cialis tablets are for oral use. Swallow the tablet whole with some water. You may take cialis with or without food.

Drinking alcohol may affect your ability to get an erection. Drinking alcohol may temporarily lower your blood pressure. If you have taken or are planning to take cialis, avoid excessive drinking (blood alcohol level of 0.08% or greater), since this may increase the risk of dizziness when standing up.

You should NOT take cialis more than once a day. Cialis 10 and 20 mg is intended for use prior to anticipated sexual activity and is not recommended for continuous daily use.If you take more cialis than you should tell your doctor.

4. POSSIBLE SIDE EFFECTS
Like all medicines, cialis can cause side effects, although not everybody gets them. These effects are normally mild to moderate in nature.

The most common undesirable effects are headache and indigestion. Less commonly reported side effects are back pain, muscle aches, nasal congestion, facial flushing and dizziness. Uncommon effects are swelling of the eyelids, eye pain and red eyes. Allergic reactions (including skin rashes, swelling of the face and hives) could occur.

In rare instances it is possible that a prolonged and possibly painful erection may occur after taking cialis. If you have such an erection, which lasts continuously for more than 4 hours, you should contact a doctor immediately.

Effects were seen in one animal species that might indicate impairment of fertility. Subsequent studies in man suggest that this effect is unlikely in humans, although a decrease in sperm concentration was seen in some men.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. FURTHER INFORMATION
What cialis contains
The active substance is tadalafil. Each tablet of cialis contains 20 mg of tadalafil.
The other ingredients are:
Tablet core: lactose monohydrate, croscarmellose sodium, hydroxypropylcellulose, microcrystalline cellulose, sodium laurilsulfate, magnesium stearate.
Film-coat: lactose monohydrate, hypromellose, triacetin, titanium dioxide (E171), iron oxide yellow (E172), talc.